Psychiatric Nursing Flashcards

A patient with dementia is agitated and repeatedly asks to go home. What is the best therapeutic response?

Answer: Use validation therapy: acknowledge the emotion and redirect with a calm, meaningful activity

Validation therapy acknowledges the patient's emotional reality (desire for safety, familiarity) without reinforcing delusion or causing distress through repeated reality orientation. Redirection to a comforting activity uses the patient's preserved emotional memory. Reality orientation in advanced dementia causes distress.

Which extrapyramidal side effect of antipsychotics is considered a medical emergency?

Answer: Neuroleptic malignant syndrome (NMS)

NMS is a rare but life-threatening reaction to antipsychotics characterized by hyperthermia, muscle rigidity, altered consciousness, and autonomic instability. Mortality can reach 10–20% without treatment. Antipsychotic must be stopped immediately and supportive care (hydration, dantrolene, bromocriptine) initiated.

A patient with major depression has been taking an MAOI antidepressant and eats aged cheese at dinner. The nurse notes blood pressure of 188/112 mmHg and severe headache. What has occurred?

Answer: Hypertensive crisis due to tyramine interaction (cheese-MAOI interaction)

MAOIs inhibit monoamine oxidase, which normally breaks down tyramine in the gut. When tyramine-rich foods (aged cheeses, cured meats, wine) are consumed, tyramine accumulates causing massive norepinephrine release and hypertensive crisis — a potentially fatal interaction.

What is the primary nursing intervention for a patient experiencing a dissociative episode?

Answer: Use grounding techniques: guide the patient to focus on the 5 senses and current physical surroundings

Grounding techniques (5-4-3-2-1 method: name 5 things you see, 4 you hear, 3 you can touch, etc.) reconnect the dissociating patient to present reality through sensory engagement. They are safe, effective, and empower the patient. Restraint can worsen trauma symptoms.

Which laboratory test should be monitored regularly in a patient taking valproic acid for bipolar disorder?

Answer: Liver function tests (LFTs) and complete blood count (CBC)

Valproic acid (valproate) is associated with hepatotoxicity and thrombocytopenia. LFTs detect liver damage; CBC detects platelet count reduction. Serum valproate levels are also monitored. Thyroid monitoring is required for lithium, not valproate.

A patient with severe anxiety is hyperventilating. What physiological change is occurring in the blood?

Answer: Respiratory alkalosis due to excess CO2 elimination causing decreased PaCO2 and elevated pH

Hyperventilation eliminates excess CO2, reducing PaCO2 (normal: 35–45 mmHg) and causing respiratory alkalosis (elevated pH). Symptoms include tingling in extremities, lightheadedness, and carpopedal spasm. Breathing into a paper bag or slowing breathing corrects the alkalosis.